for living with diabetes

GPs are being urged to ramp up diabetes treatment within just three months if they do not reach their glycaemic goals on metformin alone, under a radical update of guidelines issued by European and American diabetes societies.

The new approach would advise GPs to step up treatment by choosing between a range of diabetes therapies currently reserved for third or even fourth line, such as gliptins, exenatide or basal insulin. It also urges a progression to three-drug therapy if patients are not achieving their goals within six months of initiating treatment, and a move to multiple daily doses of insulin within nine months if goals are still not achieved.

The position statement – co-authored by Department of Health diabetes tsar Professor Rowan Hillson – says guidelines should be ‘less prescriptive’ as there is very little evidence to distinguish between options for diabetes, after metformin. Current NICE guidelines for diabetes recommend sulphonylureas are used second line, with new oral therapies reserved for when there is a particular risk of hypoglycaemia or the patient does not tolerate, or has a contraindication to, sulphylureas. Insulin is strictly reserved only if HbA1c levels remain high after other measures have been tried.

The 20-page document from the American Diabetes Association and the European Society for the Study of Diabetes dispenses with fixed HbA1c targets and says therapy regimes should be designed around the patient.